The effects of the Covid-19 pandemic on practice patterns and outcomes in patients diagnosed with gynecologic malignancies in the United States.
Authors: Adrian Kohut, Nicole Lugo Santiago, Rosemary Senguttuvan, Ernest Soyoung Han, Joshua Garrett Cohen, Stephen Lee, Thanh Hue Dellinger, Jeff Feng-Hsu Lin, Rebecca A. Nelson, Mihae Song, Ana Isabel Tergas
Journal: Journal of Clinical Oncology (2023)

5523 Background: The Covid-19 pandemic caused historic disruptions in the United States healthcare system due to many factors, including a lack of medical equipment and pharmaceutical availability, over-capacitated hospital censuses, and limited essential workers. The short- and long-term effects on patients diagnosed with gynecologic malignancies during this time have yet to be delineated. Methods: The National Cancer Database (NCDB) was queried for patients diagnosed with ovarian, uterine, and cervical malignancies from 2019 (pre-covid) to 2020 (covid). Descriptive statistics of practice patterns and outcomes were performed and compared using IBM SPSS Statistics (version 29.0). Results: Within the NCDB, 10,261 patients were diagnosed with ovarian cancer in 2019 compared to 8,501 in 2020. A significantly higher proportion of ovarian cancer patients were diagnosed with stage IV disease at diagnosis in 2020 (32.7%) compared to 2019 (30.9%), p = 0.007. Patients were less likely to undergo primary debulking surgery during covid (37.7%) compared to pre-covid (40.5%), p &lt; 0.001. There was no significant difference in time from diagnosis to initiation of treatment (median: 9 vs. 9 days), nor was there a difference in the proportion of patients undergoing cytoreductive surgery to no gross residual disease (54.3 vs. 54.3%). 42,828 patients were diagnosed with uterine cancer in 2019 compared to 37,431 in 2020. A significantly higher proportion of uterine cancer patients were diagnosed with stage IV disease at diagnosis in 2020 (8.7%) compared to 2019 (8.2%), p = 0.016. The median time from diagnosis to initiation of treatment was 28 days in 2020 compared to 30 days in 2019, p &lt; 0.001. The proportion of uterine cancer patients receiving primary radiation was higher during covid (1.7% vs. 0.5%), p &lt; 0.001. Additionally, the proportion of uterine cancer patients receiving primary hormonal management was also higher during covid (2.5% vs. 2.1%, p &lt; 0.001). 9,289 patients were diagnosed with cervical cancer in 2019 compared to 7,661 in 2020. A significantly higher proportion of cervical cancer patients were diagnosed with stage IV disease at diagnosis in 2020 (16.6%) compared to 2019 (14.9%), p = 0.0021. The median time from diagnosis to initiation of treatment was 31 days in 2020 compared to 32 days in 2019, p = 0.005. Conclusions: We identified significant variations in practice patterns and outcomes in patients diagnosed with gynecologic malignancies in the United States in 2020 (covid) compared to immediately before covid (2019). Notably, we found a significantly higher proportion of patients presenting with advanced disease stages in all queried ovarian, uterine, and cervical cancer patients. Long-term follow-up and survival outcomes are currently pending.